Provider Demographics
NPI:1265009765
Name:JOHNSON, NICHOLE (MHC)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5581 THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:NY
Mailing Address - Zip Code:14810-8215
Mailing Address - Country:US
Mailing Address - Phone:607-281-9840
Mailing Address - Fax:
Practice Address - Street 1:1019 E WATER ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-3332
Practice Address - Country:US
Practice Address - Phone:607-733-5696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health